Vaya, Cardinal merge to take on Medicaid transformation Wednesday, June 09, 2021
Two of North Carolina’s largest managed care organizations recently announced they will consolidate in preparation for the state’s transformation to Medicaid managed care.
Vaya Health and Cardinal Innovations have already begun transition efforts, with Vaya assuming responsibility for coordinating services and supports for Cardinal Innovations members once consolidated. Together, the organizations will work toward a seamless transition focused on integrated, compassionate care for individuals with mental illness, substance use disorders and/or intellectual and developmental disabilities.
Vaya Health currently manages services for individuals in 22 counties in Western North Carolina. If approved by the N.C. Department of Health and Human Services and county representatives, the consolidation will expand Vaya’s operations to encompass benefits for the individuals and cou
The first sign-up period for North Carolinaâs game-changing Medicaid transition program appears to have drawn an underwhelming â but expected â response.
Friday was the deadline for most Medicaid recipients to choose between four statewide prepaid health plans (PHP) for their physical and behavioral health coverage. The plans are scheduled to go into effect July 1.
The PHPs are operated by Centene (operating as WellCare of N.C.), AmeriHealth Caritas N.C., Blue Cross and Blue Shield of N.C. (operating as Healthy Blue) and UnitedHealth Group.
Going into Friday, DHHS said that 181,046 beneficiaries have selected a plan out of a potentially 1.6 million to 1.8 million. There are about 2.31 million Medicaid enrollees altogether, or about 22% of the stateâs overall population.
/
For the first time ever, most Medicaid patients have to choose their health plan. It’s part of North Carolina’s transition to managed care, and Charlotte’s Center for Legal Advocacy wants to make sure beneficiaries understand the changes.
“This is a completely new world for many Medicaid beneficiaries,” says attorney Rebecca Friedman with the Center for Legal Advocacy. Eligibility criteria won’t change, but Friedman says enrollees may need help to “understand what a plan network is, and what they’d have to do to ensure that they can still see their providers.”
There are 2.3 million Medicaid recipients in North Carolina, but only 1.6 million of them need to enroll in a plan. Friedman worries that some beneficiaries may be confused whether they’re one of the ones that has to sign up.